cabinet 2 (cardio-hema)

DIURETICS

promote urinary +/- electrolytes

DIURETICS - promote urinary +/- electrolytes

• K+ sparing Diuretics

K+ sparing Diuretics (Aldosterone antagonist)

Spironolactone

Spironolactone

• For resistant hypertension associated w/ hyperaldosteronism

• Essential HTN, CHF, Edema in chldn

• take with meals

A/R: Hyperkalemia; anti-androgenic effects (gynecomastia)

• DIURETICS - promote urinary +/-electrolytes

• Loop Diuretic

Furosemide

It is a SYMPATHOPLEGIC/SYMPATHOLYTIC Peripherally acting Beta-blockers:

• PROPRANOLOL, NEBIVOLOL, METOPROLOL, BISOPROLOL

It is a SYMPATHOPLEGIC/SYMPATHOLYTIC Peripherally acting Beta-blockers:

• PROPRANOLOL, NEBIVOLOL, METOPROLOL, BISOPROLOL

K+ sparing Diuretics

Aldosterone antagonist: SPIRONOLACTONE

• ALDACTONE 25, 50mg

PROPRANOLOL BN

Inderal

Nebivolol

Nebil and nebilet

Metropolol

Neobloc

Bisoprolol

Concore

Central Alpha2 agonist that crosses BBB (prodrug)

Methyldopa

HTN in PREGNANCY A/E: hepatotoxic at >2g/day; sedation; depression; positive Coomb's test

MHLN

• Methyldopa, Hydralazine, Labetalol, Nifedipine)

Where does aldomet belong

Central Alpha2 agonist: METHYLDOPA

CLONIDINE

Clonipress and catapress (75mcg)

Clonidine

Stimulates presynaptic central a2 → Dec release of
NE (vasodilation, sedation, depression) (NE is SNS = AdreSym; AdreSym - reverse of DUMBELS)

• HTNsive crisis

• Mgt of HTN among px on hemodialysis

• A/E: sedation, depression, initial transient increase in
  BP; rebound HTN (after 1 or 2 missed doses)

Clonidine

Where does captopril belong

ACEis & ARBs - Angiotensine-Converting Enzyme & Angiotensin I| Receptor Blocker

Captopril

Inhibit angiotensin-converting enzyme (from 1-2; a potent vasoconstrictor) increase bradykinin
(powerful vasodilator) = vasodilation = reduce
effect of aldosterone

Captopril BN

Captor

CALCIUM CHANNEL BLOCKERS

-dipines

Amlodipine

A CCB that is Intrinsically LONG-ACTING that causes Arteriolar vasodilation; natriuresis and diuresis

Amlodipine A/E

• myocardial depression: bradycardia; peripheral edema

Amlodipine BN

• AMVASC 5MG & 10MG

• NORVASC 5MG & 10MG

• VASALAT 5MG & 10MG

• LOPICARD 5MG & 10MG

-sartans

• Enhance efficacy when given with diuretics

• Not given together: use ACEi first; ARB if ACEi cannot be given

• A/E: hypotension, Hyperkalemia,

A miscellaneous agent that has Partial inhibition of FA oxidation and should be taken with food

• 20mg (ti); MR 35mg (bid); 80mg (OD)

Trimetazidine

Trimetazidine brands available

• ANGIREL MR

• VASTAREL MR

• VESTAR MR

NITROVASODILATORS

• EFFECTS: Peripheral vasodilation (low dose); coronary artery vasodilation and peripheral arteriolar dilation (high dose) - risk: reflex tachycardia

• Acute relief of angina pectoris

Types of nitrovasodilators

1. IsosobideDinitrate

2. IsosorbideMONOnitrate

BETA BLOCKERS

Maintenance therapy in chronic stable angina

Post-MI

CALCIUM CHANNEL BLOCKERS

• Coronary vasodilation

• Maintenance therapy in chronic stable angina

• AVOID use of short acting ___

CCB Classes

• CLASS 1: Na+ Channel Blockers

• CLASS 2: BETA BLOCKERS

• CLASS 3: K+ CHANNEL BLOCKERS: AMIODARONE

• Membrane stabilization

• 1st line for VTs and AF

• A/E: worsening arrhythmia, bradycardia, sinus arrest; headache and chest pain; hepatotoxicity

• CLASS 4: CCBs

CLASS 3: K+ CHANNEL BLOCKERS: AMIODARONE

• 200mg tid

• may be taken with or without food

• INC: 0.9% NaCl solutions; aminophylline; cefazolin, heparin, Na bicarbonate

• Contraindication: Sinus bradycardia, hypotension

Amiodarone brand

Cordarone

• Non-inotropics: Unloaders, Neurohormonal controllers

• Vasodilators: ACEis & ARBs - 1st line of therapy for HF

• ACEis: CAPTOPRIL

• ARBs: SACUBITRIL+VALSARTAN (new drug class: ARNI)

• Neprilysin inhibitor prodrug + ARB

• 1st line therapy for HF

• Hydralazine + ISDN

• Alternative to ACEi or ARB

Aspirin

an antiplatelet and a TXA2 inhibitor

ASPIRIN

• Irreversible acetylation of COX

• should be taken with food

• Contraindication: hypersensitivity to aspirin, salicylates, and other NSAIDs; history of asthma, angioedema, urticaria

• A/R: bronchospasm, asthma attack, hypersensitivity reactions

TICAGRELOR

• Inhibits platelet activation and aggregation

• can be taken with or without food. can be crushed and mixed in half a glass of water. drink immediately

• Contraindication: hypersensitivity, acive pathological bleeding

• ASPIRIN

• ASPILETS

• CLOPIDOGREL

• CLOPIVAZ

• PLATEXN

• PLOGREL

• TICAGRELOR

• BRILINTA

ANTICOAGULANT that Inhibit Xa >>> IXa, Xla, XIlla via lla

• Some LMWH: ENOXAPARIN, APIXABAN, RIVAROXABAN

DABAGATRIN

Direct Thrombin Inhibitor that directly inhibits Illa by active site binding

SULODEXIDE

A glycosaminoglycan that is an indirect thrombin inhibitor

ENOXAPARIN

• I: Deep vein thrombosis; Unstable angina;
  Pulmonary embolism

• subcutaneus

• Contraindication: hypersensitivity to heparin or its derivatives

• A/R: bleeding, skin necrosis, prosthetic heart thrombosis, hemorrhagic anemia, thrombocytosis

Enoxaparin brands

• CLEXANE, NOXADIUM, OLXARIN, ENOXAR

APIXABAN

• may be taken with or without food

• Contraindication: active pathological bleeding;

• concomitant use with other anticoagulants

• A/R: anemia, thrombocytopenia; sever hemorrhage

Apixaban brand

ELIQUIS, XAGULANT, EMBOLIS

RIVAROXABAN

• 10mg: may be taken with or without food

• 15-20mg: SHOULD be taken with food

• Contraindication: active pathological bleeding; concomitant use with other anticoagulants

• A/R: anemia, thrombocytopenia; sever hemorrhage

Rivroxaban brand

Xarelto

Glycosaminoglycan: SULODEXIDE

• Indirect thrombin inhibitor

• deep vein thrombosis

• should be taken on an empty stomach

• Contraindication: hypersensitivity to heparin

• A/R: Diarrhea, N/V

• INT: May increase anticoagulant effects of heparin and oral anticoagulants

Sulodexide brand

Vessel due F capsule

E-Aminocaproid Acid: TRANEXAMIC ACID

• Competitively inhibits conversion of plasminogen to plasmin

• May be taken with or without food

• Incomp: benzylpenicillin and blood for transfusion

• Cl: hypersensitivity

• A/R: visual defects, anemia, N/V, headache

• BRAND: HEMOSTAN capsule

Tranexamic acid brand

Hemostan

• STATINS/ HMG-CoA INHIBITORS

• ATORVASTATIN

• Inhibits HMG-CoA reductase

• May be taken with or without food. Avoid excess consumption of grapefruit juice

• A/R: Myalgia, myositis, myopathy, diarrhea, constipation, malaise, fatigue

*presence of calcium salt in atorvastatin improves drug stability

ROSUVASTATIN

• Inhibits HMG-CoA reductase

• May be taken with or without food

• Cl: Hepatic impairment - active liver disease

• A/R: myopathy, diabetes mellitus, hematuria, proteinuria,

• hypersensitivity

FENOFIBRATE

• PPAR-a agonist; upregulates lipoprotein lipase activity

• May be taken with or without food. Swallow whole and do not break/crush/open

• C/I: Hepatic Impairment

• A/R: cholelithiasis, severe decrease in HDL cholesterol,
  N/V

ADP Inhibitors: CLOPIDOGREL

• Irreversible blockade of ADP receptors (Adenosine
  DiPhosphate) - potent platelet agonist

• to reduce rate of atherothrombotic events (MI and stroke)

• may be taken with or without food

Clopidogrel

• Contraindication: Active pathological bleeding; severe hepatic impairment

• A/R: hypersensitivity rxn, acquired hemophilia, thrombocytopenia

FENOFIBRATE brand

• FENOFLEX 160MG-

• LIPANTHYL NT 145MG

• LOFIBRA 200MG

• LIPWAY SR 250MG

INSULIN SECRETAGOGUES

Sulfonylureas (2nd Gen):

• GLICLAZIDE

• DIAMICRON MR 60MG

GLIMEPIRIDE

• GETRYL 2MG

Sulfonylureas (2nd Gen):

GLICLAZIDE

• DIAMICRON MR 60MG

GLIMEPIRIDE

GETRYL 2MG

INSULIN SECRETAGOGUES

• Blocks ATP-sensitive K+ channel causing depolarization that results Ca2+ influx and enhance insulin relase from the pancreatic B-cells

• Sulfonylureas (2nd Gen): GLICLAZIDE, GLIMEPIRIDE

Sulfonylureas (2nd Gen): GLICLAZIDE, GLIMEPIRIDE

• Inhibit pancreatic release of glucagon, inc insulin receptor binding, dec hepatic extraction of insulin

• 15-20mins before breakfast (and dinner if short-acting)

BIGUANIDES

Metformin

Metformin brands

• I-MAX 500MG

• GLUMET 500MG

• GLUMET XR 500MG

• GLUCOPHAGE 500MG

• GLUCOPHAGE XR 500MG

BIGUANIDES

• Decrease liver's production of glucose via activation of AMP-activated protein kinase (AMPK)

• Stimulate glycolysis in peripheral tissues

METFORMIN

• Preferred initial therapy of T2DM esp among obese

• Mgt of pre-diabetes

• Take WITH meals

Incretins (GLP1, GIP)

• released after an oral glucose load → inc insulin release, decrease glucagon release

• DPP-IV inhibitors: SITAGLIPTIN, LINAGLIPTIN, VILDAGLIPTIN

DPP-IV inhibitors

SITAGLIPTIN, LINAGLIPTIN, VILDAGLIPTIN

SITAGLIPTIN brands

Kozta

Xelevia

Linagliptin brand

Trajenta

VILDAGLIPTIN

Proglin

Gal is

Galvusmet

Vildagliptin + Metformin

Velmetia

Sitagliptin + Metformin